Labor and Industries

							 Interested Party Request for Certified Payroll Records Note


            STEPS TO TAKE BEFORE YOU ASK FOR
         PREVAILING WAGE ASSISTANCE IN OBTAINING
               CERTIFIED PAYROLL RECORDS
 If you are an “interested party”1 you have a right under WAC 296-127-320(2) to
 request and receive certified payroll records from contractors who perform work on
 public work projects. Once you make this request, the contractor must comply by filing
 certified payroll records with the Department of Labor & Industries (L&I) and with the
 project awarding agency.

 If the contractor does not provide the records in response to your direct request, you
 may also request them from either L&I’s prevailing wage program or from the
 awarding agency through a public records request. If the prevailing wage program or
 the awarding agency does not already possess the records, there is no requirement in
 the law that says they must obtain them to satisfy your request.

 However, as time and resources permit, in instances where we do not possess the
 records at the time we receive your request, we may assist you in your efforts by
 directly asking the contractor to provide them to us. Before you ask us to obtain the
 records from the contractor, please first:
      1) request the records directly from the contractor; and
      2) if the contractor does not provide the records, request them from the contract
          awarding agency.
 If, after taking those steps, you are unable to obtain the records, you may complete
 and submit to us the attached form and we will respond to the request as soon as we
 are able. Please include with the form documentation that you have completed steps
 (1) and (2) above.

 When we receive the records, prior to sending them to you we will redact all employee
 social security numbers.

 If you have questions about this process, please contact us at (360) 902-5335 or
 pw1@Lni.wa.gov.


 L. Ann Selover
 Industrial Statistician
 Prevailing Wage Program Manager
 1
     An "interested party" for the purposes of this chapter shall include a contractor,
     subcontractor, an employee of a contractor or subcontractor, an organization whose
     members' wages, benefits, and conditions of employment are affected by this
     chapter, and the director of labor and industries or the director's designee. [RCW
     39.12.010(4)]


F700-141-000 04-2012
 Department of Labor and Industries
 Prevailing Wage Program
                                                                                              Interested Party Request for L&I
 PO Box 44540                                                                                      Assistance in Obtaining
 Olympia, WA 98504-4540                                                                           Certified Payroll Records
 PWCertPay@Lni.wa.gov
 Phone: (360) 902-5335                                                                                WAC 296-127-320
 Fax: (360) 902-5300

I certify that I contacted the Awarding Agency and Contractor of Interest listed below to request these certified payroll
records prior to filing this request to L&I to assist me in obtaining these records. I have not received those records.
Attached to this document is proof of the two requests.

 Requestor Details:                                                                Please send records to (if different from requestor):
 Name:                                                                             Name:
 Organization:                                                                     Organization:
 Address:                                                                          Address:
 City:                                             State:         Zip:             City:                                      State:          Zip:
 Phone Number:                                                                     Phone Number:
 Email:                                                                            Email:
I request assistance in obtaining certified payroll records for the following:
 Project Title:
 Bid Date:                                                                         Contract Number:
 Intent ID:                        Affidavit ID:                     The records requested are for the dates of:          to

 Contractor of Interest:
 License Number:                                                                  UBI Number:
 Mailing Address:                                                                 City:                         State:                 Zip:
 Contact:                                                Phone Number:                                          Fax Number:

 Awarding Agency:
 Mailing Address:                                                                 City:                         State:                 Zip:
 Contact:                                                Phone Number:                                          Fax Number:

 Prime Contractor:
 License Number:                                                                  UBI Number:
 Mailing Address:                                                                 City:                         State:                 Zip:
 Contact:                                                Phone Number:                                          Fax Number:

I choose to inspect the records received by L&I at no charge before selecting copies.                     Yes      No
Photocopies may be charged at 15 cents per copy.
I choose to accept from L&I the records as they are received from the employer, which may be incomplete.        Yes                             No
If the records are incomplete and I need the missing information, I will contact L&I and request further assistance.
I certify that I will not use the requested records for commercial purposes in the event that a list of individuals is included
in the material provided. The Department of Labor and Industries defines commercial as communication with the
individuals named in the record for the purpose of facilitating profit-expecting activity.


 Date:                          Name:                                                Signature:




F700-141-000 Interested Party Request for L&I Assistance in Obtaining Certified Payroll Records 04-2012